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Home My WebLink AboutLang cciroo ® ria Town Hall53095 Main Road ` P.O. Box 1179 ® 1, t oif Southold, New York 11971 JUDITH T.TERRY ,�� FAX(516)765-1823 �� TELEPHONE(516)765-1801 TOWN CLERK REGISTRAR OF VITAL STATISTICS OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL PERMIT OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. 1406-R Residential X Non-Residential Fee $ 10.00 Septic Cesspool X New Existing X Name Of Owner LANG, ELLEN V. Mailing Address 1 P. O. BOX 425 Mailing Address 2 City St Zip SOUTHOLD NY 11971-0000 Property Address 1 3055 WELLS AVENUE Property Address 2 City St Zip SOUTHOLD NY 11971-0000 Owner Telephone No. 516-765-2908 Tax Map No. section 70.00 block 4 lot 11 .000 Cross Street OAKLAWN AVENUE Date Of Last Pump Out 0/00/86 dgeouropecoat,... Issue Date: 3/09/90 Judith T. Terry Southold Town Clerk (TOWN SEAL) • „. OFFICE OF THE TOWN CLERK \FFD r� Town of Southold O� Cpm• Application No./Va=. Judith T. Terry, Town Clerk 1*t 4.% 4 y Town Hall, 53095 Main Road ;74 I $10.00 - Residential p, O. Box 1179 =� ° cry4 �� $25.00 - Non-Residential •�`Southold, New York 11971 O ® `. Telephone ®jy � r (516) 765-1801 TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISPOSAL DISTRICT APPLICATION for OPERATION PERMIT SEPTIC TANK or CESSPOOL Operation Permit No. Fee $ / (j DATE OWNER NAME: Va��pd-- • • OWNER MAILING ADDRESS: a/42a,, OWNER PROPERTY ADDRESS: �`s�-�� G� OWNER TELEPHONE NUMBER: 7 -s — '" (/ L TAX MAP NO. : Section Block Lot CROSS STREET: TYPE OF SYSTEM: Septic Tank New Existing Cesspool ✓ New Existing Residential Non-Residential DATE OF PREVIOUS PUMP-OUT: /9P6 LOCATION MAP: Must be attached hereto before permit may be issued. (Locate building and system; give north arrow and feet of distance, approximately, to building and closest road.) 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